Past Splash winner Breakthrough navigates the ACA

With healthcare costs on the rise, telepsychiatry startup Breakthrough is staying optimistic

When healthcare stagnates, what does Silicon Valley do? It innovates. Oh, the Affordable Care Act still won’t require insurers to cover fertility treatments? Glow innovates. The cost of healthcare has gotten so prohibitively high that patients aren’t going to their doctors for preventative care? HealthTap mother*cking innovates.

One company that can be counted among some of the great innovators is telepsychiatry startup Breakthrough, which makes mental healthcare accessible to all through remote video sessions with real psychiatrists, psychologists, therapists, and counselors.

The 2010 Vator Splash winner has gone on to raise $6 million in angel and venture funding, and it’s seeing some real results with its users. A full 80% of patients who use Breakthrough report an improvement in their symptoms, and 86% rebook after their first appointment. A whopping 60% of patients say that Breakthrough enabled care they wouldn’t have otherwise received. That’s two out of three users saying that they didn’t have other alternatives for mental healthcare.

But how will Breakthrough fare with the rollout of the Affordable Care Act? Insurance costs are rising and high deductibles are sure to make preventative care prohibitively expensive. Just taking a quick glance at the Covered California website, a family of four living in San Jose and making a combined income of $75,000 a year can expect to pay roughly $350 a month in premiums and slog through a family deductible of $10,000. TEN. THOUSAND. As in—dollars. Meaning: you have a baby and the hospital charges $35,000—you’re on the hook for $10,000 of that.

That’s sure to have very real ramifications for mental healthcare as well. If patients can expect to pay $10,000 out-of-pocket before their insurance kicks in, how likely will they be to acknowledge troubling symptoms?

In 2012 (the most recent year for which the Substance Abuse and Mental Health Services Administration has data), 43.7 million Americans experienced mental illness. Less than half—41%--received help. The number one reason for forgoing mental healthcare services: the cost. Some 48% said they simply couldn’t afford treatment, compared to 28% who simply figured they could handle the problem on their own, and 23% who didn’t know where to go to get treatment.

Those with private health insurance were less likely than those with Medicaid or CHIP to receive treatment, but those without any health coverage at all were the least likely to receive treatment.

So how will those bode for Breakthrough as more insurers shuck the high cost of healthcare in the U.S. onto patients?

CEO Mark Goldenson is optimistic.

“The ACA is complex and wide-ranging enough that it's hard to predict the effects, but I think there's a good chance that increased access to care will lower costs,” said Goldenson.

Currently, 75% of Breakthrough’s patients pay with insurance and 25% pay out-of-pocket, which is consistent with in-person care stats.

But access is the first part of the equation. The SAMHSA report notes that those without coverage are least likely to seek out treatment, so by virtue of the fact that more people will be covered, Breakthrough can probably count on seeing more patients access its services. Additionally, major expansions to Medicaid means even more people will have access to mental health services that they didn’t previously.

Goldenson also notes that there are several ways that Breakthrough can help lower costs.

Firstly, there’s earlier treatment. Mental health treatment gets more expensive as symptoms become more severe, and telehealth services are a cost-effective and efficient way to treat mild to moderate symptoms before they spin out of control.

Secondly, we return to the importance of access. People in rural areas are just as likely as those in urban areas to suffer from mental illness, but they’re treated half as often. Some 90 million people live in a mental health provider shortage area, according to U.S. Health and Human Services. Those people are more likely to self-medicate through drugs or alcohol, or go to the emergency room. So it stands to reason that if you make mental health services more readily available, you’ll prevent mild mental illness from blowing up into more severe disorders.

And thirdly, Goldenson says Breakthrough helps patients find providers they can trust. Research has shown that good fit (“therapeutic alliance”) is a strong indicator for positive outcomes. A third of Breakthrough’s providers have video introductions that Breakthrough actually pays to film, and most have detailed profiles.

Additionally, ensuring that online mental healthcare is covered by insurance is another way that Breakthrough is lowering costs. Historically, online therapy hasn’t been covered by insurance providers, but Breakthrough has been working on that and plans to double its partner insurers to eight this year. It also plans to add group therapy sessions in the near future, which will give patients the chance to give and receive group support while also cutting down costs.

Some other ways Breakthrough plans to make mental healthcare more accessible to patients in 2014: the company plans to launch mobile video sessions, increase its number of launch states to ten, and form relationships with primary care providers who can then refer patients to Breakthrough.

Will insurance bureaucracy and soaring deductibles cause hiccups down the road? Possibly. But Goldenson notes that the key to reducing costs will be in making services accessible so people can address problems before they spiral out of control.

“A key will be people using their care and changing unhealthy behaviors,” said Goldenson. “No amount of insurance coverage can save us from the harmful effects of smoking, eating unhealthy, and not getting enough sleep.”